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Vol. 72. Issue 7.
Pages 543-552 (July 2019)
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Vol. 72. Issue 7.
Pages 543-552 (July 2019)
Original article
DOI: 10.1016/j.rec.2018.05.012
Quality of Care and 30-day Mortality of Women and Men With Acute Myocardial Infarction
Calidad del cuidado y mortalidad a 30 días de mujeres y varones con infarto agudo de miocardio
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Carla Araújoa,b,,
Corresponding author
carla-r-araujo@hotmail.com

Corresponding author: EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal.
, Olga Laszczyńskaa,, Marta Vianaa,c, Paula Diasd, Maria Júlia Macield, Ilídio Moreirab, Ana Azevedoa,c,e
a EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
b Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Hospital de São Pedro, Vila Real, Portugal
c Centro de Epidemiologia Hospitalar, Centro Hospitalar São João, EPE, Porto, Portugal
d Serviço de Cardiologia, Centro Hospitalar São João, EPE, Porto, Portugal
e Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Figures (1)
Tables (3)
Table 1. Baseline Demographic, Socioeconomic, and Medical History Characteristics of Women and Men With Acute Myocardial Infarction
Table 2. Clinical Presentation, Patient and System Delays, Risk Stratification, and Management of Women and Men With Acute Myocardial Infarction
Table 3. Quality of Care According to the European Society of Cardiology Acute Cardiovascular Care Association Quality Indicators for Women and Men With AMI
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Abstract
Introduction and objectives

Despite increased awareness of sex disparities in care and outcomes of acute myocardial infarction (AMI), there appears to have been no consistent attenuation of these differences over the last decade. We investigated differences by sex in management and 30-day mortality using the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QIs) for AMI.

Methods

Proportions and standard errors of the 20 Acute Cardiovascular Care Association QIs were calculated for 771 patients with AMI who were admitted to the cardiology departments of 2 tertiary hospitals in Portugal between August 2013 and December 2014. The association between the composite QI and 30-day mortality was derived from logistic regression.

Results

Significantly fewer eligible women than men received timely reperfusion, were discharged on dual antiplatelet therapy and high-intensity statins, and were referred to cardiac rehabilitation. Women were less likely to receive recommended interventions (59.6% vs 65.2%; P < .001) and also had higher mean GRACE 2.0 risk score-adjusted 30-day mortality (3.0% vs 1.7%; P < .001). An inverse association between the composite QI and crude 30-day mortality was observed for both sexes (OR, 0.08; 95%CI, 0.01-0.64 for the highest performance tertile vs the lowest).

Conclusions

Performance in AMI management is worse for women than men and is associated with higher 30-day mortality, which is also worse for women. Evidence-based QIs have the potential to improve health care delivery and patient prognosis in the overall AMI population and may also bridge the disparity gap between women and men.

Keywords:
Quality indicators
Acute myocardial infarction
Mortality
Women
Abbreviations:
ACS
AMI
NSTEMI
PCI
QI
STEMI
Resumen
Introducción y objetivos

A pesar de una mayor conciencia de las disparidades en el tratamiento y los resultados entre mujeres y varones con infarto agudo de miocardio (IAM), no parece que en la última década se hayan atenuado estas diferencias. El objetivo del estudio es identificar diferencias por sexo en el tratamiento y la mortalidad a 30 días utilizando los indicadores de calidad de la Asociación de Cuidados Cardiovasculares Agudos de la Sociedad Europea de Cardiología para el IAM.

Métodos

Se calcularon las proporciones y los errores estándar de los 20 indicadores de calidad en 771 pacientes con IAM que ingresaron en el servicio de cardiología de 2 hospitales terciarios en Portugal entre agosto de 2013 y diciembre de 2014. La asociación entre el indicador de calidad compuesto y la mortalidad a 30 días se analizó por regresión logística.

Resultados

Significativamente menos mujeres que varones elegibles recibieron una reperfusión oportuna, tratamiento antiagregante plaquetario doble y estatinas de alta intensidad al alta y rehabilitación cardiaca. Las mujeres recibieron con menos frecuencia las intervenciones recomendadas (el 59,6 frente al 65,2%; p < 0,001) y también tuvieron una puntuación más alta del riesgo GRACE 2.0 ajustado por la mortalidad a 30 días (el 3,0 frente al 1,7%; p < 0,001). Se observó una asociación inversa entre el indicador de calidad compuesto y la mortalidad bruta a 30 días en ambos sexos (tercil de mayor rendimiento en comparación con el menor, OR = 0,08; IC95%, 0,01-0,64).

Conclusiones

El porcentaje de mujeres que recibieron tratamiento óptimo en el IAM fue menor que el de varones y se asoció con una mayor mortalidad a los 30 días. Los indicadores de calidad basados en directrices tienen el potencial de mejorar la prestación y el pronóstico de la atención médica de los pacientes con IAM en general y también de reducir la brecha entre mujeres y varones.

Palabras clave:
Indicadores de calidad
Infarto agudo de miocardio
Mortalidad
Mujeres

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